Resumen

OBJETIVO: Establecer si la obesidad mórbida durante el embarazo se asocia con incremento de la morbilidad y mortalidad materna y perinatal versus mujeres con peso normal.

MATERIALES Y MÉTODOS: Estudio de cohortes, con seguimiento prospectivo, ambispectivo, con recolección de datos de las historias clínicas de pacientes atendidas en el Complexo Hospitalario de Ourense, España (2014- 2017). Se incluyeron pacientes embarazadas con obesidad mórbida y con peso normal, y se asignaron al azar para su comparación. Para determinar la asociación potencial entre las variables, y para detectar su relación o interacción, se efectuaron pruebas paramétricas y no paramétricas.

RESULTADOS: Se estudiaron 139 mujeres (48 embarazadas con obesidad mórbida y 91 sin obesidad) y se encontró incremento en la incidencia anual de embarazadas con obesidad mórbida (IMC ≥ 40 kg/m²) en quienes se registró mayor propensión a padecer estados hipertensivos del embarazo e hipotiroidismo gestacional, con diferencia estadística a favor de la inducción del parto y terminación del embarazo mediante cesárea (riesgo de 4.29; IC95%: 2.02-9.08). En cuanto a los desenlaces neonatales, la cohorte con obesidad tuvo más recién nacidos macrosómicos, valores alterados en el Apgar al primer minuto e ingreso del recién nacido a cuidados intensivos. 

CONCLUSIONES: En nuestro medio se ha incrementado la incidencia de mujeres embarazadas con obesidad mórbida. La obesidad clase III durante el embarazo incrementa el riesgo de complicaciones materno-fetales. 

PALABRAS CLAVE: Obesidad, mórbida; peso normal; mujeres embarazadas; hipertensión inducida por el embarazo; diabetes gestacional; índice de masa corporal.

Abstract

OBJECTIVE: Establish whether morbid obesity during pregnancy is associated with increased maternal and perinatal morbidity and mortality (gestational diabetes, hypertensive states of pregnancy, premature delivery, fetuses with intrauterine growth retardation, macrosomia, neonatal death, etc.) in comparison with women with normal weight.

MATERIALS AND METHODS: Cohort study, with prospective follow-up and ambispective data collection of the Clinical History in the Ourense´s Hospital (Spain) between 2014 and 2017. Pregnant women with morbid obesity and non-obese random pregnant women were included for comparison. Parametric /nonparametric tests were performed to determine the potential association between the variables and to detect the relationship or interaction between the different variables, as well as the correlations.

RESULTS: A total of 139 women were included (48 pregnant women with morbid obesity and 91 pregnant women without obesity). There was an increase in the annual incidence of pregnant women with morbid obesity. Patients with BMI ≥ 40 Kg/m² were significantly more likely to have gestational diabetes, requiring insulin therapy more frequently. A greater propensity to develop hypertensive states of pregnancy (mainly gestational hypertension) and gestational hypothyroidism. We found statistical differences in favor of induction and delivery by caesarean section in pregnant women with morbid obesity. There was a risk of 4.29 (95% CI:2.02-9.08) of a woman with morbid obesity ending her pregnancy by caesarean section. It stands out in the neonatal results, that the cohort with obesity presented an increase of macrosomic newborns, altered values ​​of the Apgar test at the first minute and neonatal admission.

CONCLUSIONS: The incidence of pregnant women with morbid obesity in our environment has increased. Class III obesity during pregnancy increases the risk of maternal-fetal complications.

KEYWORDS: Obesity, morbid; Normal weight; Pregnant women; Hypertension, pregnancy-induced; Diabtes, gestational; Body Mass Index.